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Access over workers' compensation decisions, including En Banc, Significant Panel Decisions, and writ-denied cases.

Case No. GOL 96757
Regular
Jun 10, 2008

SA YANG LO vs. CUSTOM SENSORS & TECHNOLOGIES, INC., STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board denied reconsideration of a prior award, upholding the application of the 2005 Permanent Disability Rating Schedule. The Board found that exceptions allowing for the 1997 Schedule did not apply, as the applicant's temporary disability indemnity extended beyond January 1, 2005, and no qualifying pre-2005 reports indicated permanent disability. Furthermore, the Board found the applicant's vocational expert's opinion regarding diminished future earning capacity unpersuasive, thus affirming the initial 9% permanent disability rating.

Workers' Compensation Appeals BoardSA Yang LoCustom Sensors & TechnologiesInc.State Compensation Insurance FundGOL 96757Opinion and Order Denying ReconsiderationFindings and AwardWorkers' Compensation Administrative Law JudgeWCJ
References
Case No. ADJ2965812 (SAC 0308365)
Regular
Apr 23, 2012

CHRISTINE KRAUSE vs. STATE OF CALIFORNIA, SECRETARY FOR RESOURCES AGENCY, Legally Uninsured, Adjusted By STATE COMPENSATION INSURANCE FUND

The Workers' Compensation Appeals Board (WCAB) rescinded an order compelling the defendant to provide cervical spine surgery, deferring the issue pending a final report from a Spinal Surgery Second Opinion Physician (SSSOP). The SSSOP's report was delayed beyond the statutory 45-day timeframe, but the WCAB found neither party was at fault for this delay, and obtaining the SSSOP's opinion was crucial for a proper decision. The WCAB dismissed the defendant's petition for removal. A dissenting commissioner argued the defendant should be liable for the surgery due to the delayed process, citing precedent that placed the burden on the employer to ensure timely adherence to statutory procedures.

Workers' Compensation Appeals BoardPetition for ReconsiderationSpinal Surgery Second Opinion PhysicianUtilization ReviewLabor Code Section 4062(b)Industrial InjuryCervical Spine SurgeryTreating PhysicianIndustrial InjuryDeclaration of Readiness to Proceed
References
Case No. OAK 263916
Regular
Jun 04, 2008

JEFFREY HONEYWELL vs. SAFEWAY STORES

The Workers' Compensation Appeals Board denied lien claimant Bay Surgery Center's petition for reconsideration, upholding the administrative law judge's decision to award partial payment for medical services. The Board also dismissed Safeway Stores' petition for reconsideration as untimely filed. Additionally, the Board admonished the lien claimant's representative for unprofessional comments made about the judge.

Bay Surgery Centerdiscographypump proceduresitemized billsLabor Code section 4603.2substantial evidencereasonableness of chargespenalty assessmentpenalty for unreasonable delayfictitious name permit
References
Case No. ADJ7307502
Regular
Jul 11, 2011

GABRIELA NAVARRO vs. VENGROFF WILLIAMS ASSOCIATES, STATE COMPENSATION INSURANCE FUND

This case concerns an applicant seeking Lap Band surgery for an industrial injury. The Workers' Compensation Appeals Board (WCAB) denied the petition for reconsideration of the administrative law judge's decision. The applicant's primary argument was that an Agreed Medical Examiner (AME) supported the surgery's reasonableness and benefits. However, the WCAB found the AME's testimony contradictory and lacking specific evidence that Lap Band surgery was "reasonably required to cure or relieve" the effects of the industrial injury. Furthermore, the WCAB noted the AME's expressed lack of expertise regarding bariatric surgery and a timely utilization review that did not support the surgery.

Workers Compensation Appeals BoardGabriela NavarroVengroff Williams AssociatesState Compensation Insurance FundLap Band surgeryIndustrial injuryAgreed Medical EvaluatorStephen WertheimerM.D.Utilization Review
References
Case No. VNO 0396976
Regular
Feb 01, 2008

MARIA MARTINEZ vs. STATE OF CALIFORNIA, DEPARTMENT OF SOCIAL SERVICES, STATE COMPENSATION INSURANCE FUND

The Appeals Board granted reconsideration, rescinded the prior order, and returned the case to the trial level. The WCJ erred by applying the 2004 Outpatient Surgery Center Fee Schedule; instead, the court must determine a reasonable fee based on the *Kunz* precedent. This requires developing the record to consider factors like the provider's usual fees and geographic area rates, not solely the fee schedule.

KunzSB Surgery Centerlien claimantreasonable feeoutpatient surgery center fee scheduleprima facie evidenceWCJAppeals Boardpermanent disabilityfuture medical treatment
References
Case No. STK 0175350
Regular
Jul 08, 2008

FRANCIS NZIBO vs. KAISER PERMANENTE, CALIFORNIA WORKERS' COMPENSATION

This case involves applicant Francis Nzibo's claim for penalties against Kaiser Permanente for alleged unreasonable delay in providing cervical surgery. The Workers' Compensation Appeals Board is issuing a notice of intention to dismiss the petition for reconsideration as moot because there is no evidence presented as to whether the applicant has actually undergone the authorized surgery. If surgery was not performed, no compensation payment was delayed, rendering the penalty claim moot.

Moot petitionPetition for reconsiderationCervical surgeryUnreasonable delayMedical care provisionPenaltiesWCJ findingsLabor Code section 5814Authorization of surgeryFailure to present
References
Case No. ADJ3699477 (OAK 0345390)
Regular
Jul 05, 2011

GARY TOMEI vs. BAY ALARM COMPANY, TRAVELERS PROPERTY AND CASUALTY INSURANCE COMPANY

This case involves an applicant seeking authorization for cervical surgery, which was denied based on the treating physician's request not being properly formatted per AD Rule 9792.6(o). The Appeals Board granted reconsideration, finding the initial denial was due to the applicant's attorney adding a notation to the physician's report instead of the physician clearly marking it as a spinal surgery authorization request. The Board rescinded the original award, deferring the cervical surgery issue and ordering an expedited second opinion from a designated orthopedic surgeon or neurosurgeon.

Workers' Compensation Appeals BoardGary TomeiBay Alarm CompanyTravelers Property and Casualty Insurance CompanyADJ3699477Opinion and Order Granting Reconsiderationcervical surgerylumbar spineAdministrative Director Rule 9792.6(o)treating physician
References
Case No. ADJ9546300 ADJ9103215
Regular
Apr 21, 2015

JAMES TUBBS vs. FRESNO CHAFFEE ZOO, NATIONWIDE AGRIBUSINESS INSURANCE COMPANY

The Workers' Compensation Appeals Board (WCAB) granted reconsideration and reversed a prior decision, finding the applicant is not entitled to a second lumbar surgery. The WCAB concluded that the applicant failed to meet the burden of proof by providing substantial medical evidence demonstrating the surgery's reasonableness and necessity, as required by Labor Code sections 5705 and 4600. While acknowledging the prior successful surgery, the WCAB found Dr. Aryan's request lacked sufficient support based on established medical treatment guidelines. The dissenting opinion argued that substantial medical evidence supported the surgery and that the defendant's delays unfairly prejudiced the applicant.

ADJ9546300ADJ9103215lumbar spine injuryDr. Francisco UnguezDr. Henry AryanRequest for Authorization (RFA)surgery authorizationL4-S1 surgeryDubon IIsubstantial medical evidence
References
Case No. ADJ8513866
Regular
Oct 11, 2013

GARY HICKS vs. COUNTY OF SACRAMENTO

The Appeals Board granted reconsideration of an award for future medical treatment, including spinal surgery, stemming from a 1996 industrial injury. The defendant employer argued that no reporting doctors addressed causation for the surgery. The Board noted the defendant's violation of rules by submitting unadmitted exhibits. Consequently, the Board amended the award to defer the issue of whether the 1996 injury contributes to the need for surgery, returning the matter for further proceedings to develop the record on causation.

Workers' Compensation Appeals BoardPetition for ReconsiderationFindings and AwardFuture Medical TreatmentSpinal SurgeryCausationLabor Code section 4062 (b)Substantial EvidencePropria PersonaPanel Qualified Medical Examiner (QME)
References
Case No. ADJ2897160
Regular
Dec 13, 2010

JAMES HUTCHRAFT vs. PAN MOTORCYCLES, INC., UNIVERSAL UNDERWRITERS GROUP

In this workers' compensation case, James Hutchcraft sought penalties and attorney's fees for alleged unreasonable delays in authorizing a surgical consultation and cervical surgery. The Appeals Board denied his petition for reconsideration, affirming the administrative law judge's decision. The Board found that Hutchcraft failed to meet his burden of proving any delay by the defendant in authorizing the consultation or the surgery. Lacking evidence of a delay, the issue of reasonableness was not reached.

Workers' Compensation Appeals BoardPetition for ReconsiderationLabor Code Sections 58145814.5Unreasonable DelayAuthorizationOrthopedic SurgeonCervical SurgeryBurden of ProofMedical Treatment
References
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